Welcome

Hello

Welcome to the 117th Critical Care Reviews Newsletter, bringing you the best critical care research published in the past week, plus a wide range of free full text review articles, guidelines, commentaries and editorials from hundreds of clinical and scientific journals.

This week's research studies include randomized controlled trials on dexmedetomidine during non-invasive ventilation, vasopressin and corticosteroids in septic shock, contrast-induced nephropathy and caspofungin prophylaxis; meta analyses address hydrocortisone for septic shock, delirium interventions in the critically ill, anti-TNFα therapy in sepsis and ICP monitoring in traumatic brain injury; while observational studies focus on stress ulcer prophylaxis plus lung recruitment in ARDS. There are also several other additional studies of interest.

There are two guidelines this week, including a multi-societal, and endorsed by ESICM, paper on hyponatraemia, as well as a Korean paper on influenza. One study critique looks at the TTM study, while editorials also address temperature management, consent to publish and medical reversal. Commentaries focus on influenza, tolvaptan, subcutaneous emphysema and testosterone. Amongst the clinical review articles are papers on sugammadex, stroke thrombolysis, intracranial hypertension, serelaxin, both cardiology and respiratory updates from 2013, contrast-induced nephropathy, micafungin, and metamphetamine abuse. One non-clinical review article discusses the role of revalidation in Australia.

The beginning of each month marks the addition of recently made open access articles from the major critical care journals, with the latest papers from the American Journal of Respiratory and Critical Care Medicine, Chest, Critical Care, Anesthesiology, Anesthesia & Analgesia, British Journal of Anaesthesia, Anaesthesia, and Anaesthesia and Intensive Care all added.

It's just two weeks to SMACCgold, the biggest critical care conference in the Southern Hemisphere. If you're coming along, there are a number of workshops the day before the main meeting starts, including one on Evidence-Based Medicine, being run by Simon Carley and Rick Body from Manchester, England, with me helping out. Simon and Rick have been busy, and have posted pre-course material on their excellent St. Emlyns blog. Check out Simon and Rick's other website, BestBETs, to learn how to perform a pragmatic appraisal of the evidence to answer a specific clinical question. If you want to improve your ability to appraise the literature, understand statisitcs and improve your journal club, then this is the workshop to attend. We're hoping each attendee will be able to produce an evidence-based appraisal that might just get published! Of course, the day before the workshop is St Patricks Day, where SMACCgold becomes SMACCgreen - it promises to be fun. Follow on twitter (@critcarereviews) for the latest news and I'll tweet whatever is planned. I hope to see you on the Gold Coast, Queensland, Australia. Be sure to say hi.

FFICM Exam

Earlier this week I gave a Hot Topics talk at the National FFICM Preparation Course in London. Both references and slides of a collection of most know research papers and guidelines from 2013 and 2012 are available here.

Research

Devlin and colleagues completed a double blind, randomized, placebo-controlled trial, investigating the efficacy and safety of dexmedetomidine (n=16), in the presence of protocolized midazolam and fentanyl sedation, for non-invasive ventilation in 33 patients with early acute respiratory failure, and found:

Gordon and colleagues undertook a multi-centre, open-label, randomized controlled pilot trial, in 61 patients with septic shock, evaluating the addition of IV hydrocortisone (50 mg 6 hourly, n=31) or placebo (n=30) to a vasopressin infusion (titrated up to 0.06 U/min), examining for an interaction between vasopressin and corticosteroids in septic shock, and found:

Ostrosky-Zeichner and colleagues undertook a multicenter, randomized, double-blind, placebo-controlled trial of caspofungin as either pre-emptive or prophylactic antifungal therapy in 222 patients at risk for invasive candidiasis, and found:

Al-Qadheeb reviewed data from 17 trials (n=2,849) examining whether interventions that are effective at reducing the duration of delirium are associated with a reduction in short-term mortality, and found:

delirium duration was

lower in the intervention groups

difference 0.64 day; 95% CI -1.15 to -0.13; p = 0.01

reduced by ≥ 3 days in three studies

0.1 to < 3 days in six studies

0 day in seven studies

< 0 day in one study

short-term mortality was not reduced in 13 studies reporting this outcome